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INTRODUCTION

THEY suffer silently, consumed by a dread of sexual pleasure and filled with fear and sexual self-doubt. They feel profoundly at odds with a culture that tirelessly promotes sex but is strangely unconscious about sexuality. It is not inhibited sexual desire they are experiencing, although often they possess a naiveté, an innocence, or even a prejudice against sex. It is not sexual dysfunction, although their suffering often wears the mask of physical problems that affect sex. It is not about being cold and unresponsive although that certainly is a way in which they protect themselves against the hurt. It is not about religious belief, although religious sexual oppression may have been a place to hide. It is not about guilt and shame, although those feelings are powerfully experienced. Nor is it about sexual betrayal or risk or rejection, although those are common themes. It is simply the emptiness of profound deprivation, a silent suffering called sexual anorexia.

Sexual anorexia is an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one's life. Like self-starvation with food or compulsive debting or hoarding with money, deprivation with sex can make one feel powerful and defended against all hurts. As with any other altered state of consciousness, such as those brought on by chemical use, compulsive gambling or eating, or any other addiction process, the preoccupation with the avoidance of sex can seem to obliterate one's life problems. The obsession can then become a way to cope with all stress and all life difficulties. Yet, as with other addictions and compulsions, the costs are great. In this case, sex becomes a furtive enemy to be continually kept at bay, even at the price of annihilating a part of oneself.

The word anorexia comes from the Greek word orexis, meaning appetite. An-orexis, then, means the denial of appetite. When referring to food appetite, anorexia means the obsessive state of food avoidance that translates into self-starvation. Weight concerns and fear of fat transform into a hatred of food and a hatred of the body because the body demands the nurturance of food. Food anorexics perceive bodily cravings for sustenance as a failure of self-discipline. The refusal to eat also becomes a way for food anorexics to reassert power against others, particularly those who may be perceived as trying to control the anorexic, trying in some manner to prevent the anorexic from being his or her "true" self. Ironically, many food anorexics are driven by a powerful need to meet unreal cultural standards about the attractiveness of being thin. A terror of sexual rejection rules their thoughts and behaviors and is a primary force behind this striving for thinness. The irony here is that sexual anorexics share precisely the same terror.

Specialists in sexual medicine have long noted the close parallels between food disorders and sexual disorders. Many professionals have observed how food anorexia and sexual anorexia share common characteristics1 In both cases, the sufferers starve themselves in the midst of plenty. Both types of anorexia feature the essential loss of self, the same distortions of thought, and the agonizing struggle for control over the self and others. Both share the same extreme self-hatred and sense of profound alienation. But while the food anorexic is obsessed with the self-denial of physical nourishment, the sexual anorexic focuses his or her anxiety on sex. As

• a result, the sexual anorexic will typically experience the following:
  
  
• a dread of sexual pleasure
  
  
• a morbid and persistent fear of sexual contact
  
  
• obsession and hypervigilance around sexual matters
  
  
• avoidance of anything connected with sex
  
  
• preoccupation with others being sexual
  
  
• distortions of body appearance
  
  
• extreme loathing of body functions
  
  
• obsessional self-doubt about sexual adequacy
  
  
• rigid, judgmental attitudes about sexual behavior
  
  
• excessive fear and preoccupation with sexually transmitted diseases
  
  
• obsessive concern or worry about the sexual intentions of others
  
  
• shame and self-loathing over sexual experiences
  
  
• depression about sexual adequacy and functioning
  
  
• intimacy avoidance because of sexual fear
  
  
• self-destructive behavior to limit, stop, or avoid sex

Sexual anorexics can be men as well as women. Their personal histories often include sexual exploitation or some form of severely traumatic sexual rejection - or both. Experiences of childhood sexual abuse are common with sexual anorexics, often accompanied by other forms of childhood abuse and neglect. As a result of these traumas, they may tend to carry dark secrets and maintain seemingly insane loyalties that have never been disclosed. In fact, sexual anorexics are for the most part not conscious of the hidden dynamics driving them. Although obsessed with sexual avoidance, they are nonetheless also prone to sexual bingeing - occasional periods of extreme sexual promiscuity, or "acting out" - in much the way that bulimics will binge with compulsive overeating and then purge by self-induced vomiting. Sexual anorexics may also compensate with other extreme behaviors such as chemical or behavioral addictions, co-dependency, or deprivation behaviors like debting, hoarding, saving, cleaning, or various phobic responses. The families of sexual anorexics may also present extreme patterns of behavior and thought. Finally, the sexual anorexic is likely to have been deeply influenced by a cultural, social, or religious group that views sex negatively and supports sexual oppression and repression.

Sexual anorexia, therefore, can wear many masks. Consider the sexual trauma victim who takes care of her pain by compulsively overeating. People focus on her obesity, not noticing the hidden anorexic agenda of avoiding being desirable to anyone. Or think of the alcoholic who has never been sexual except when drinking. The prospect of being sexual while sober is so intimidating that a broader "abstinence" is embraced. For most sexual anorexics, however, a complex array of extremes exists. When a person's appetites are excessive we use words like addiction or compulsion. But excesses are often accompanied by extreme deprivations for which we use terms like anorexia or obsession. In fact, these seemingly mutually exclusive states can exist simultaneously within a person and within a family. Consider the case of a sexually addicted alcoholic heterosexual male. The further his drinking and sexual behavior get out of control, the harder and more compulsively his wife works (the more she behaves hyperresponsibly), and the more she shuts down sexually (anorexia). These disorders are not occurring in isolation. But the end result is that the problem of sexual anorexia is not likely to get addressed because it lacks the clarity and drama of the drinking, the sexual acting out, and the workaholism.

People minimize the problem of sexual anorexia. After all, whoever died of a lack of sex? Yet, as we shall see in this book, the physical and psychological consequences of sexual anorexia are severe, and the problem is central to understanding the entire mosaic of extreme behaviors.

This book focuses on the suffering of the sexual anorexic. Sexual anorexia is as destructive as the illnesses that often accompany it, and behind which it often hides, such as alcoholism, drug addiction, sexual addiction, and compulsive eating. It resides in emotion so raw that most sufferers would wish to keep it buried forever were it not so painful to live this way. Sexual anorexia feeds on betrayal, violence, and rejection. It gathers strength from a culture that makes sexual satisfaction both an unreachable goal and a nonnegotiable demand. Our media focus almost exclusively on sensational sexual problems such as rape, child abuse, sexual harassment, or extramarital affairs. When people have problems being sexual, we are likely to interpret the difficulty as a need for a new technique or a matter of misinformation. For those who suffer from sexual anorexia, technique and information are not remotely enough. Help comes only through an intentional, planned effort to break the bonds of obsession that keep anorexics stuck.

This book is intended as a guide to support that effort. The early chapters help the reader understand sexual anorexia: how it starts, and how it gathers such strength. The last twelve chapters present a clinically tested and proven plan for achieving a healthy sexuality. This program has worked for many, many people. It is safe. It is practical. It works if the sufferer follows the guidelines and has the appropriate outside support. It will not be easy because the obsession was created in the first place by intimate violations and shattered trust. Yet step by step, healing can be effected so that the sufferer can learn to trust the self as well as others.

The plan is designed to involve a network of external support made up of partners, therapists, close friends, clergy, and so on. The book will explain the importance of having these "fair witnesses" along on the journey to health and freedom. Breaking the isolation is essential to dismantling the dysfunctional beliefs and loyalties that keep people in pain.

The material in this book can be used in many settings. Some people have used these materials in the Twelve Step groups dedicated to sexual problems, many of which now feature subgroups dedicated to sexual anorexia. Couples groups dedicated to recovery such as Recovering Couples Anonymous have also used these materials as a guide. Therapists have used them in individual and group therapeutic sessions.

Many observers, including myself, have noticed that sexual anorexics are generally competent and willing people. As they face their illness, they begin to reclaim their creativity and start becoming the persons they were meant to be. There is something fundamental about coming to terms with the sexual self, something healing and liberating. In the "Big Book" of Alcoholics Anonymous one of the promises of recovery is "we shall know a new freedom!" This book is dedicated to making that so.